Most anyone who has ever engaged with healthcare in the U.S. — whether on the receiving end as a patient, or as a provider — can tell you it’s an industry ripe for change. This is especially apparent when you compare healthcare to certain other industries fueled by unceasing innovation, such as tech and financial services firms.
It often feels like healthcare organizations are at least a few years behind the times, struggling to modernize in a fast-paced world fraught with challenges — but also rife with opportunities to improve patient outcomes and streamline operations.
But change is coming, spurred on by technological developments, new entrants into the sector and the increasing pressure from all sides to lower costs while improving care. Here are just four examples of disruptions the healthcare industry is facing, now and in the months and years to come.
Moving Beyond Fee-for-Service Care Models
Despite spending almost double on healthcare what other countries with comparable incomes do, the U.S. routinely sees worse outcomes in population health and lower levels of care access.
Many experts believe traditional fee-for-service models, which pay providers for every service they perform whether or not it’s essential or impactful, are a big part of the problem. This approach tends to drive up the price for insurers — and, in turn, patients — while costing providers more to sustain.
The ramp up to value-based healthcare is set to disrupt the industry in the coming years. Under value-based care, providers get paid based on measurable patient outcomes — incentivizing them to recommend the most relevant care.
Here are a few ways orgs may benefit from embracing value-based care, per Managed Healthcare Executive:
- Bundling transactions into episodes rather than requiring separate paperwork for every procedure, reducing administrative workload.
- Incentivizing teams to take measures to improve care quality based on data findings, like hiring a hospitalist aiming to reduce readmission rates of patients having surgery (rather than relying on primary care doctors alone for care).
- Aligning providers and payers toward the same goal of improved care at streamlined costs.
The eventual, hopeful result? Stronger population health, fewer adverse events, less waste and lower costs throughout the ecosystem.
Retailers Entering the Healthcare Space
Healthcare delivery is increasingly taking place outside the walls of traditional hospitals, practices and pharmacies. Here are a few prime examples of this development, according to experts for Managed Healthcare Executive:
- The acquisition of PillPack, an online pharmacy, by Amazon — for nearly a billion dollars.
- The potential for a retailer like Walmart to acquire an insurance provider like Humana, a deal that’s been rumored to be in early stages since 2018. Another example was CVS Health acquiring Aetna.
- Haven — also known as the joint healthcare venture between Berkshire Hathaway, J.P. Morgan an Amazon — to reduce healthcare costs for their workers.
- Emergence of retailers emphasizing price transparency and at-home delivery, like HealthWarehouse.
Retail is disrupting healthcare by bringing its relentlessly customer-centric mindset into an industry in which consumers have long felt they have less agency than they’d like — and to address issues like lack of transparency, high costs and trouble accessing care.
More AI & Data-Driven Decision Making
Earlier we mentioned a shift toward centering patient outcomes under value-based care, and this approach depends heavily on — you guessed it — data. Advances in healthcare data analytics, like self-service search and artificial intelligence tools, are empowering decision-makers throughout organizations to access and incorporate data insights into their workflows.
This data-led disruption goes hand in hand with the rise of connected health, the Internet of Things (IoT), and Electronic Health Records (EHR). Clinicians, researchers, and administrators are accessing richer stores of data as they make decisions that impact care/cost quality, supply chains, overhead expenses, staffing and more.
Growing Need to Embrace Technology
It sounds like a given, but technology will only continue to disrupt and modernize healthcare — and many organizations still have a long way to go on this front.
As Healthcare Dive cites, as of 2019, fewer than one-third of leaders said EHRs are their top source of clinical data (30.1 percent). About three-fourths of leaders reported their organizations are using patient portals; just over half are harnessing telehealth and options for digital payment. As more organizations incorporate the existing and new tech available, we’ll see more change in terms of cost and outcomes. And, of course, an increase in tech means an influx of data — which orgs can then put to work through analytics and AI.
Healthcare is due for disruption from tech, analytics, retailers, and reimbursement models. The good news is there are lots of opportunities here to adapt and innovate.